Fluid and Electrolyte Therapy

Types of therapy
1. Maintenance therapy o Provides water, electrolytes, glucose, vitamins, and in some instances protein to meet daily requirements. 2. Restoration of deficits o In addition to maintenance therapy, fluid and electrolytes are added to replace previous losses. 3. Replacement therapy o Infusions to replace current losses in fluid and electrolytes.

Types of intravenous fluids

1. Isotonic solutions

a. Fluids that approximate the osmolarity (280-300 mOsm/L) of normal blood plasma.

Sodium Chloride (0.9%) - Normal Saline

Indications:

Extracellular fluid replacement when Cl- loss is equal to or greater the Na loss. Treatment of matebolic alkalosis. Na depletion Initiating and terminating blood transfusions.

Possible side effects:

Hypernatremia Acidosis Hypokalemia Circulatory overload.

b. Five percent dextrose in water (D5W).

Provides calories for energy, sparring body protein and preventing ketosis resulting from fat breakdown.

Indications:

Dehydration Hypernatremia Drug administration

Possible side effects:

Hypokalemia Osmotic diuresis dehydration Transient hyperinsulinism Water intoxication.

c. Five percent dextrose in normal saline (D5NS).

Prevents ketone formation and loss of potassium and intracellular water.

Indications:

Hypovolemic shock temporary measure. Burns Acute adrenocortical insufiency.

Possible side effects:

Hypernatremia Acidosis Hypokalemia Circulatory overload

d. Isotonic multiple-electrolyte fluids.

Used for replacement therapy; ionic composition approximates blood plasma.

Types:

a. Plasmanate b. Polysol c. Lactated Ringers

Indications:

Vomiting Diarrhea Excessive diuresis Burns

Possible side effects:

Circulatory overload. Lactated Ringers is contraindicated in severe metabolic acidosis and/or alkalosis and liver disease. Hypernatremia

Acidosis Hypokalemia

2. Hypertonic solutions

Fluids with an osmolarity much higher than 310 mOsm (+ 50 mOsm); increase osmotic pressure of blood plasma, thereby drawing fluid from cells.

a. Ten percent dextrose in normal saline

Administered in large vein to dilute and prevent venous trauma.

Indications:

Nutrition Replenish Na and Cl.

Possible side effects:

Hypernatremia (excess Na) Acidosis (excess Cl) Circulatory overload.

b. Sodium Chloride solutions, 3% and 5% Indications:

Slow administration essential to prevent overload (100 mL/hr) Water intoxication Severe sodium depletion

3.

Hypotonic solutions

Fluids whose osmolarity is significantly less than that of blood plasma (-50 mOsm); these fluids lower plasma osmotic pressure, causing fluid to enter cells.

a. 0.45% sodium chloride

Used for replacement when requirement for Na use is questionable.

b. 2.5% dextrose in 0.45% saline, also 5% in 0.2 % NaCl

Common rehydrating solution.

Indications:

Fluid replacement when some Na replacement is also necessary.

Encourage diuresis in clients who are dehydrated. Evaluate kidney status before instituting electrolyte infusions.

Possible side effects:

Hypernatremia Circulatory overload Used with caution in clients who are edematous, appropriate electrolytes should be given to avoid hypokalemia.

Table of Commonly Used IV Solutions

Name of Solution Type of Solution Hypotonic pH 5.6 Shorthand Notation: NS 0.9% Sodium Chloride Ingredients in 1-Liter 77 mEq Sodium 77 mEq Chloride Uses Complications

0.45% Sodium Chloride

hypotonic hydration; replace sodium and chloride; hyperosmolar diabetes

if too much is mixed with blood cells during transfusions, the cells will pull water into them and rupture

Isotonic pH 5.7

154 mEq Sodium 154 mEq Chloride

isotonic hydration; replace sodium and chloride; alkalosis; blood transfusions (will not hemolyze blood cells)

None known

Shorthand Notation: NS

3% Sodium Chloride

Hypertonic pH 5.0

513 mEq Sodium 513 mEq Chloride symptomatic hyponatremia due to excessive sweating, vomiting, renal impairment, and excessive water intake rapid or continuous infusion can result in hypernatremia or hyperchloremia

5% Sodium Chloride

Hypertonic pH 5.8

855 mEq Sodium 855 mEq Chloride

5% Dextrose in Water

Isotonic pH 5.0

5 grams dextrose (170 calories/liter)

isotonic hydration; provides some calories

Shorthand Notation: D5W water intoxication and dilution of bodys electrolytes with long, continuous infusions

10% Dextrose in Water

Hypertonic pH 4.3

10 grams dextrose (340 calories/liter)

may be infused peripherally; hypertonic hydration; provides some calories

Shorthand Notation: D10W

5% Dextrose in 1/4 Strength (or 0.25%) Saline

Hypertonic pH 4.4

5 grams Dextrose 34 mEq Sodium 34 mEq Chloride

fluid replacement; replacement of sodium, chloride and some calories

Shorthand Notation: D5NS

5% Dextrose in 0.45 Sodium Chloride

Hypertonic pH 4.4

5 grams Dextrose 77 mEq Sodium 77 mEq Chloride

hypertonic fluid replacement; replace sodium, chloride, and some calories

vein irritation because of acidic pH, causes agglomeration (clustering) if used with blood transfusions; hyperglycemia with rapid infusion leading to osmotic diuresis

Shorthand Notation: D5NS

5% Dextrose in Normal Saline

Hypertonic pH 4.4

5 grams Dextrose 154 mEq Sodium 154 mEq Chloride

hypertonic fluid replacement; replace sodium, chloride and some calories

Shorthand Notation: D5NS

Ringers Injection, U.S.P.

Isotonic pH 5.8

147 mEq Sodium 4 mEq Potassium 4 mEq Calcium 155 mEq Chloride

electrolyte replacement; hydration; often used to replace extracellular fluid losses

rapid administration leads to excessive introduction of electrolytes and leads to fluid overload and congestive conditions; provides no calories and is not an adequate maintenance solution if abnormal fluid losses are present

Lactated Ringers

Isotonic pH 6.6

130 mEq Sodium 4 mEq Potassium 3 mEq Calcium 109 mEq Chloride 28 mEq Sodium Lactate (provides 9 calories/liter)

isotonic hydration; replace electrolytes and extracellular fluid losses; mild to moderate acidosis (the lactate is metabolized into bicarbonate which counteracts the acidosis)

Shorthand Notation: LR

not enough electrolytes for maintenance; patients with hepatic disease have trouble metabolizing the lactate; do not use if lactic acidosis is present 5% Dextrose in Lactated Ringers Injection Hypertonic pH 4.9 5 grams Dextrose (170 calories/liter) 130 mEq Sodium Shorthand Notation: 4 mEq Potassium D5LR 3 mEq Calcium 109 mEq Chloride 28 mEq Sodium Lactate (provides 9 calories/liter) hypertonic hydration; provides some calories; replace electrolytes and extracellular fluid losses; mild to moderate acidosis (the lactate is metabolized into bicarbonate which counteracts the acidosis), the dextrose minimizes glycogen depletion